Healthcare Provider Details

I. General information

NPI: 1134423858
Provider Name (Legal Business Name): CLINIC FOR ASSESSMENTS AND NEEDS OF DEVELOPMENTALLY DELAYED INDIVIDUAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD SUITE 605
ENCINO CA
91436
US

IV. Provider business mailing address

16055 VENTURA BLVD SUITE 605
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-233-0058
  • Fax:
Mailing address:
  • Phone: 818-233-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 47315
License Number StateCA

VIII. Authorized Official

Name: CURT WIDHALM
Title or Position: OWNER
Credential:
Phone: 818-233-0058